Tuberculosis in Eswatini

SEATTLE, Washington — Eswatini is a small landlocked country located in Southern Africa with a population of around 1.1 million. Eswatini, formerly called Swaziland, ranks high for its rates of infectious and contagious diseases. For example, Eswatini had the highest rate of adult HIV infection in 2016. Similar to HIV, tuberculosis poses a serious threat to public health in Eswatini. The International Association for Medical Assistance to Travellers rated tuberculosis in Eswatini as “highly endemic,” meaning that tuberculosis is a common occurrence.

What is Tuberculosis?

The Center for Disease Control (CDC) breaks down tuberculosis simply by explaining that it is a disease caused by bacteria. “The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain.” Some people with TB are asymptomatic. Thus, there is a disparity between individuals who unknowingly have tuberculosis and others who can become very ill. Common symptoms include chest pain, a strong cough lasting three or more weeks and coughing up blood or sputum.
In its 2019 Global Tuberculosis Report, the World Health Organization (WHO) reported that around 10 million people suffer from tuberculosis illness every year. The disease is “one of the top 10 causes of death” around the world. Additionally, tuberculosis has a high incidence of coinfection with HIV. WHO reports that it is “the leading cause of death” for HIV Positive people. Of the Swazis who were knowingly HIV-positive, 69% also had tuberculosis in 2017. This is the highest rate of tuberculosis-HIV coinfection in the world.

Tuberculosis in Eswatini

In 2017, The CDC estimated that the incidence of tuberculosis in Eswatini was 308 per 100,000 people. However, the mortality rate for tuberculosis was low at only 10 per 100,000 people in 2019. This is significantly lower than the 2003 mortality rate of 18 per 100,000 people. The National Tuberculosis Control Programme (NTCP) estimates that “children account for only 10%” of all Swazis with tuberculosis.
Though these rates may seem low, tuberculosis in Eswatini is still a serious public health issue. Swazis may not be dying from the disease as they once were, but they continue to live with it. Approximately 47% of Swazis with tuberculosis have gone undetected. The organization believes that the solution to the high rate of tuberculosis in Eswatini must include early detection of the disease.

Preventing and Treating Tuberculosis

Though the effects of tuberculosis in Eswatini are serious, there are organizations doing what they can to prevent and treat the illness. Internally, the NTCP reports that, as of 2015, 85 of the country’s 86 healthcare facilities were adhering to its National Tuberculosis Infection Prevention and Control guidelines.
The CDC is one organization that works directly with the Ministry of Health (MOH) of the Kingdom of Eswatini to address tuberculosis infection. The CDC especially focuses on providing technical assistance to promote combined tuberculosis and HIV aid. This assistance includes testing, preventative treatment, and antiretroviral treatment. Its efforts have been effective as the organization reported the tuberculosis treatment rate of success to be 83% in 2016.
ICAP at Columbia University has taken practical steps to establish routine testing and prevention for tuberculosis in Eswatini. ICAP worked with the MOH and the NTCP to make these practices more regular, specifically in women’s healthcare. As women come to HIV clinics, “cough-officers” screen them for tuberculosis symptoms. Part of this strategy’s effectiveness is that these clinics are now “one-stop-shops.” Women do not need to make additional visits elsewhere to be tested or treated for tuberculosis. If they test positive, treatment is readily available. If they test negative, they may take a six-month course on Tuberculosis Preventive Therapy.

Tuberculosis in Eswatini remains a prominent threat to public health. The situation is serious, especially because it often goes undetected. However, many scientific organizations are taking action to prevent and treat tuberculosis illness. As they carry on the reduction of tuberculosis from the past two decades, hope is on the horizon.

Hannah Simpson
Photo: Flickr


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